Ingraham et al1 explored the relationship, or lack thereof, among outcomes for elective general surgery, emergency general surgery, and trauma at the hospital level. The acute care surgery model is an initiative to combine the specialty of trauma with the field of emergency general surgery. In reality, emergency general surgery care is extremely vast in how it is delivered, with thousands of hospitals engaged in treating patients throughout the country. However, in the United States, the trauma system is sustained by only 325 to 350 American College of Surgeons–verified trauma centers. I suspect that enactment of rigorous quality improvement at many trauma centers, beyond the arena of trauma patients, is likely still in its infancy. Hence, a potential reason for the negative findings of this study.